Term
Two types of strokes:
Which is most common?
Which is most severe? |
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Definition
ischemic hemorrhagic (less common/most debilitating) |
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Term
How is each type of stroke named? |
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Definition
Hemorrhagic is named by bleed location
Ischemic is named by etiology |
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Term
The pathway of an ischemic stroke |
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Definition
1. Occlusion 2. Ischemia 3. Toxic cascade |
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Term
What events lead to the occlusion? |
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Definition
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Term
In ischemia what is occurring to the tissue? |
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Definition
Reduced nutrient/waste exchange Anaerobic metabolism Ion shifts |
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Term
Explain the toxic cascade |
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Definition
1. Excess of excitatory A.A. 2. Inflammation mediators 3. Free radical production |
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Term
What co-morbidities are associated with a hemorrhagic stroke |
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Definition
Trauma Infection Uncontrolled HTN tumor Abnormal vessels |
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Term
Ultimately a hemorrhagic stroke manifests as... |
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Definition
Increased cranial space volume |
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Term
What are the 3 Cincinnati Pre-hospital Stroke Test criteria? |
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Definition
1. Facial droop 2. Arm drift 3. Abnormal speech |
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Term
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Definition
1. CT scan (quick) 2. MRI (longer) |
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Term
Ways to prevent a stroke from ever occuring |
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Definition
1. BP control 2. No smoking 3. Anti-platelet therapy if appropriate 4. Anti-coagulation therapy if CHADS >/= 2, or PT has A. fib 5. Statin therapy if needed |
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Term
Describe the line drawn across the body that determines if a pt will need anti-platelet or anti-coagulation therapy |
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Definition
Clot above shoulders = anti-platelet Clot below shoulders = anti-coagulation |
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Term
The CHADS scale is for what type of PTs? |
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Definition
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Term
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Definition
1 - CHF 1 - HTN 1 - Age >/= 75 1 - Diabetes 2 - Stroke/TIA (previous)
@ or more anti-coagulation therapy |
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Term
When is it okay to use rt-PA (Alteplase)? |
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Definition
ISCHEMIC stroke ONLY Within the first 4 hours |
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Term
What are six contraindications to using rt-PA (Alteplase)? |
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Definition
1. Symptoms have began to improve 2. Heparin within the last 48 hours 3. Active internal bleeding 4. Intra cranial surgery in the last 3 months 5. Seizure occurred at the stroke's 6. onset BP > 185/110 |
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Term
How is rt-PA (Alteplase) dosed? |
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Definition
0.9mg/kg IV
10% bolus 90% infusion over 1 hr
Max 90mg |
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Term
How is rt-PA (Alteplase) monitored |
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Definition
Hours 1: every 15min Hours 2-7: every 30min Hours 8-24: every hour Hours 25+: every shift |
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Term
What is monitored after rt-PA (Alteplase) administration |
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Definition
1. Bleeding 2. Neurological recovery 3. PT/INR/aPTT 4. Hemoglobin/Hematocrit 5. Cranial CT scan |
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Term
What trial confirmed rt-PA to be effective in ischemic stroke treatment? |
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Definition
NINDS - Nat. Institute of Neurological Disorders |
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Term
BY how much does rt-PA improve ischemic stroke outcomes according to the NINDS trial? |
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Definition
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Term
What trial determined Aspirin to be an effective anti-platelet treatment? |
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Definition
The international stroke trial |
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Term
What trial determined that pts on aspirin had better outcomes? |
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Definition
CAST (Chinese Acute Stroke Trial) [160-325mg used in trial] |
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Term
What is the role of uf-heparin/LMWH in stroke pts? |
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Definition
3-4 days after rt-PA if the pt has some paralysis, then they need uf-hep/LMWH to prevent a VTE |
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Term
What is the dosing of of uf-heparin/LMWH? |
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Definition
UFH = 5000u SQ q8-12h Enoxaparin = 40mg SQ qDAY Dalteparin 2500u SQ qDAY |
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Term
What single factor makes the largest difference in stroke recurrence? |
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Definition
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Term
What BP therapy is preferred in post stroke pts? |
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Definition
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Term
How is dyslipidemia treated post stroke? |
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Definition
80mg atorvastatin regardless of baseline LDL |
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Term
The brand name drug Aggrenox consist of what combination of drugs? |
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Definition
200mg Dipyridamole + 25mg Aspirin |
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Term
What trial showed a dipyridamole/aspirin combination drug like Aggrenox would be an effective treatment? |
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Definition
ESPS-2 European Stroke Prevention Study-2 |
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Term
Describe the results of the CAPRIE (Clopidogrel vs. Aspirin in Pt Risk for Ichemic Events) trial |
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Definition
Clopidogrel is less likely to cause MI and GI hemorrhage |
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Term
In the CAPRIE trail clopidogrel beat out plain aspirin, but what was discovered in the ProFESS trial? |
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Definition
Aggrenox (cdipyridamole/aspirin combo drug) was equivalent to clopidogrel alone |
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Term
The MATCH (MGMT of atherothrombis w/ Clopidogrel in High riskj prs) trial compared Clopidogrel alone vs. a clopidogrel/aspirin combo products. What was the result in these pts? |
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Definition
The combination of clopidogrel and aspirin greatly reduced hemorragic strokes & life threatening bleeding |
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Term
Anti-platelet therapy should be monitored in 3 ways |
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Definition
1. Signs/symptoms of bleeding 2. Signs/symptoms of stroke 3. CBC |
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Term
How are direct XA inhibitors (rivaroxaban/apixaban) different from WARFARIN in anti-coagulation therapy? |
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Definition
1. Cost more 2. unable to monitor 3. no antedote 4. Higher risk of MI |
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Term
Which direct xa inhibitor has a storage issue? |
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Definition
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Term
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Definition
Normal 150mg PO BID Renal Reduced 75mg PO BID |
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Term
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Definition
Normal 20mg PO qDAY Renal reduced 15mg PO qDAY |
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Term
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Definition
Normal 5mg PO BID High risk 2.5mg BID
(High risk = age>/= 80, =/< 60kg, SCr>/=1.5mg/dL) |
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Term
The RELY study determined |
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Definition
The efficacy/safety of dabigatran to be greater than WARFARIN |
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Term
The Rocket-AF study determined |
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Definition
The efficacy/safety of drivaroxaban to be greater than WARFARIN |
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Term
The ARISTOTLE study determined |
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Definition
The efficacy/safety of apixiban to be greater than WARFARIN |
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